Hip Fracture Research Articles

Perioperative Pain Observation of Hip Fracture Surgery Patients with Cheek Acupuncture

Perioperative Pain Observation of Hip Fracture Surgery Patients with Cheek Acupuncture

Characteristics and Management of Neck and Trochanteric Femur Fractures at a Tertiary Hospital in Indonesia: A Retrospective, Single-Center Study

Background: Although hip fractures are common among the elderly population, there are still limited studies on neck-trochanteric fractures, one of the less common types of hip fractures. This study aims to describe the characteristics of patients and their management in patients with neck trochanteric fractures. Methods: This retrospective cross-sectional study analyzed medical records of patients aged >18 years with trochanteric fractures from a tertiary hospital in Central Java, Indonesia, between January and December 2021. Fracture types were identified and classified using the Garden, Pauwels, and AO/OTA classifications. Demographic data, risk factors, fracture locations, and treatment types were also collected. Statistical analysis was performed using SPSS 21.0 to describe patient characteristics. Results: The total sample was 77 patients, most were female (n = 55 (71.4%)) and aged > 60 years. More than a third of diagnosed fractures were neck of the femur fractures in 33 patients (42.9%). Among the most common classification types of fractures were Garden Type 3, Pauwels Type 3, and AO/OTA type A1.1. A total of 33 patients (42.9%) underwent open reduction of the fracture with internal fixation. Conclusions: Our findings show that the prevalence of neck-trochanteric fractures mostly occurs in patients > 60 years of age and in females. Although open reduction with internal fixation is generally performed, there are several cases of fractures that are not classifiable due to limited imaging examinations. Further research on a wider population is needed to confirm the findings of this study.

The Effect of Intermittent Pneumatic Compression Device Combined with Low-Molecular-Weight Heparin on the Prevention of Deep Vein Thrombosis in Elderly Patients after Femoral Neck Fracture Surgery.

Aims/Background Femoral neck fractures in elderly patients carry a high risk of developing deep vein thrombosis (DVT) due to prolonged immobilization and surgical intervention. This study examines the effectiveness of combining intermittent pneumatic compression (IPC) with low-molecular-weight heparin (LMWH) for preventing DVT in elderly patients following femoral neck fracture surgery. Methods A total of 150 elderly patients with femoral neck fractures, admitted between January 2022 and January 2024, were retrospectively selected, and their clinical data were analyzed. Based on the treatment methods, the patients were divided into a control group (n = 71) and a study group (n = 79). The control group received LMWH treatment, while the study group received a combination of LMWH and IPC. The incidence of DVT, surgical outcomes, hip joint function, coagulation function indicators, hemodynamic indicators, and serum pro-inflammatory factors were compared between the two groups. Results The results showed that the incidence of DVT in the study group was lower than in the control group (p = 0.017). There were no significant differences between the two groups in terms of intraoperative blood loss, postoperative drainage volume, or Harris scores (p > 0.05). After the intervention, the study group demonstrated higher levels of average velocity (Va), peak blood flow velocity (Vp), and blood flow (BF) compared to the control group (p < 0.05). Additionally, the activated partial thromboplastin time (APTT) and prothrombin time (PT) were longer, while the D-dimer (D-D) level was lower in the study group (p < 0.05). The study group also exhibited lower levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) (p < 0.05). Conclusion The results indicate that combining IPC with LMWH effectively reduces the incidence of postoperative DVT in elderly patients with femoral neck fractures, improves venous blood flow in the lower limbs, reduces vascular inflammation, and ensures safety.

Analgesic regimens administered to older adults receiving skilled nursing facility care following hip fracture: a proof-of-concept federated analysis

BackgroundAlthough a majority of patients in the U.S. receive post-acute care in skilled nursing facilities (SNFs) following hip fracture, large-sample observational studies of analgesic prescribing and use in SNFs have not been possible due to limitations in available data sources. We conducted a proof-of-concept federated analysis of electronic health records (EHRs) from 11 SNF chains to describe analgesic use during hip fracture post-acute care.MethodsWe included residents with a diagnosis of hip fracture between January 1, 2018 and June 30, 2021 who had at least one administration of an analgesic. Use of analgesics was ascertained from EHR medication orders and medication administration records. We quantified the proportion of residents receiving analgesic regimens based on the medications that were administered up to 100 days after hip fracture diagnosis. Plots visualizing trends in analgesic use were stratified by multiple resident characteristics including age and Alzheimer’s Disease and Related Dementias (ADRD) diagnosis.ResultsThe study included 23,706 residents (mean age 80.5 years, 68.6% female, 87.7% White). Most (~ 60%) residents received opioids + APAP. Monotherapy with APAP or opioids was also common. The most prevalent regimens were oxycodone + APAP (20.1%), hydrocodone + APAP (15.8%), APAP only (15.1%), tramadol + APAP (10.4%), and oxycodone only (4.3%). During the study period, use of APAP-only increased, opioids-only decreased, and opioids + APAP remained stable. Use of APAP-only appeared to be more prevalent among individuals aged > 75 years (versus ≤ 75 years) and those with ADRD (versus without).ConclusionsWe successfully leveraged federated SNF EHR data to describe analgesic use among residents receiving hip fracture post-acute care.

Determination of Bone Fracture Risk in Kidney Transplant Recipients With FRAX Score

Background:It is thought that the Fracture Risk Assessment Tool(FRAX) score of the World Health Organization determines a 10-year fracture risk.The study aimed to investigate the major osteoporotic fracture(MOF) and hip fracture(HF) values determined with the FRAX score and practicality of the FRAX score in kidney transplant recipients(KTRs).Methods:The study was conducted with 44 female and 59 male KTRs and 100 healty control group.Bone mineral density(BMD) was measured by dual-energy X-ray absorptiometry.FRAX scores were calculated from baseline information (age, height, weight, BMD femur neck T score,previous fracture history, glucocorticoid use, smoking status, alcohol consumption,and presence of rheumatoid arthritis).Results:In KTRs, FRAX score MOF, and FRAX score HF were found to be significantly elevated, while BMD femur T score was determined to be significantly low. No significant relationship was found between FRAX score MOF and HF and kidney function tests and bone parameters. In the ROC analysis performed based on the determination of the FRAX score the cutoff point was determined as≥3.4 for MOF and≥0.4 for HF.Conclusion:In KTRs, increased FRAX score MOF and HF compared to healthy individuals were determined.FRAX score MOF≥3.4 and HF≥0.4 values indicate high-risk patients for increased fracture risk.The high accuracy rates determined suggest that the use of the FRAX score in KTRs is a valuable method for determining fracture risk.

Ambulation recovery prediction after hip fracture surgery using the Hip Fracture Short-Term Ambulation Prediction tool.

To develop models for predicting postoperative ambulation recovery at 3 months following fragility hip fracture surgery. Cross-sectional study. Fragility hip fracture patients aged ≥ 50 years who underwent operative treatment and completed a 3-month follow-up. Potential predictors were collected from eligible patients, while ambulation at 3 months after injury was assessed using the modified functional ambulation classification. These factors were used to develop the Hip Fracture Short-Term Ambulation Prediction, consisting of 2 models: Model 1 for postoperative ambulation and Model 2 for preinjury status recovery. Among the 275 patients, 55 (20.0%) achieved good ambulation, and 59 (21.5%) returned to their preinjury status at 3 months. Age, preinjury ambulatory status, and discharge ambulatory status were identified as significant predictors of 3-month postoperative ambulation. The tool presented (Models 1 and 2) showed strong performance (area under the curve of 0.86 and 0.85, respectively) and good internal validity. Age, preinjury ambulatory status, and discharge ambulatory status significantly predict postoperative ambulation and preinjury status recovery at 3 months after fragility hip fracture surgery. The tool presented may aid clinicians in identifying patients who could benefit from targeted rehabilitation interventions during this crucial period.

Fractures at various skeletal sites are dependent on different risk factors: the results from 10 years of prospective longitudinal observation in postmenopausal women from the RAC-OST-POL Study.

The aim of the study was to present data on risk factors for fractures in various parts of the skeleton in a cohort of postmenopausal women during a 10-year prospective observation period. It can be hypothesised that fracture risk factors should be different for spine, hip, and peripheral fractures. 640 postmenopausal women at mean baseline age was 65.0 ± 6.9 years were enrolled into the study. The cohort was randomly selected from the population of the entire Racibórz district. Data on the incidence of fractures and falls were updated annually during the 10-year follow-up period. Information on clinical risk factors for fractures was collected at baseline. During the observation period, 190 low-traumatic fractures were recorded in 129 patients. The following number of fractures was observed: hip 15, spine 30, non-hip fractures other than spine 145 (including 81 forearm fractures). The effect of falls was insignificant in the case of spine fractures (chi-square test: 3.64; p = 0.06). For all other skeletal sites, the incidence of fractures was significantly increased by falls, with the greatest effect observed for forearm fractures and non-spine and non-hip fractures (chi-square test for hip, forearm, and all non-spine, non-hip fractures was 6.43, p < 0.05; 42.7, p < 0.0001 and 66.7, p < 0.0001, respectively). To determine the factors having a significant impact on the incidence of fractures during the observation period, logistic regression was used separately in subgroups. The following risk factors were taken into account: age, height, body weight, bone mineral density (BMD) at the femoral neck as expressed by T-score, rheumatoid arthritis, steroid use, falls reported at baseline, and the total number of risk factors. Spine fractures depended only on T-score, odds ratio (OR) = 0.42 (0.23-0.76); hip fractures depended only on age, OR = 1.15 (1.07-1.24); forearm fractures depended only on age T-score, OR = 0.69 (0.51-0.92); and non-hip, non-spine on fall rate, OR = 1.86 (1.20-2.87). Fractures at various skeletal sites recorded in long-term follow-up in postmenopausal women were dependent on various risk factors. Multivariate analysis identified a single, dominant risk factor for each fracture location analysed.

Impact of rigorous muscle strength and power training on mobility among individuals with hip fractures: A randomized controlled trial

Patient’s mobility is not restored to pre-fracture levels until two years following a fractured hip. A persistent weakness in the muscles on the fractured leg may contribute to mobility limitations. A randomized controlled trial was conducted on individuals with hip fractures aged 60-85 to examine the effect of strength and power training twice a week on mobility. A random assignment was made between a 46-person intervention group and a 40 person control group. Over a period of twelve weeks, strength training was conducted twice per week under supervision. All measurements were conducted by a blinded measurer. We assessed mobility by timing the time it takes to climb stairs, get up from a chair, and walk. To analyze the data, we used intention-to-treat analysis. A study of efficacy was conducted for subjects who adhered to training more than 50% of the time (n = 40). 4 of the controls did not show a statistically significant improvement in mobility (p &lt;0.001). Training had no significant effect on walking time or TUG. During the efficacy analysis, the average chair rise time for the exercise group improved by 5.4% (p &lt; 0.005). The results of intense muscle strength and power training were observed in self-reported improvements in mobility. Participants with higher training compliance had an improved chair rise rate.

Correlation Analysis of Limb Length Differences and Surgical Approaches Following Unilateral Total Hip Arthroplasty

Aim: This research aims to analyze the transition from the posterolateral approach (PLA) to the direct anterior approach (DAA) in 101 cases of unilateral total hip arthroplasty (THA). In addition, the study specifically aims to evaluate limb length discrepancy (LLD). Methods: We conducted a retrospective analysis of 101 patients who had unilateral THA from September 2021 to August 2024. The causes of THA included femoral neck fracture (n = 28), osteoarthritis (n = 23), osteonecrosis of the femoral head (n = 25), and developmental dysplasia of the hip (n = 25). The mean age was 61.50 years in the PLA group and 63.00 years in the DAA group. Safety feasibility was assessed by analyzing procedure time, incision length, and bleeding volume. LLD was indirectly evaluated by measuring the difference in central edge angles of the postoperative pelvic orthotopic plate. This was done to assess the superiority of the DAA. Results: The DAA group had a longer operation time, less blood loss, and a shorter incision length compared to the PLA group, with a statistically significant difference (P &lt; 0.05). Additionally, body mass index was found to be linearly correlated with operation length. The LLD in the DAA group was significantly smaller than that in the PLA group (P &lt; 0.05). Moreover, this LLD was linearly associated with the difference in the central edge angle. Conclusion: DAA may effectively control LLD after THA, resulting in less blood loss and shorter incisions, though it may require longer operative time.

Oral Nutritional Supplementation in Older Adults with a Hip Fracture-Findings from a Bi-National Clinical Audit.

Evidence-based guidelines and care standards recommend offering oral nutrition supplements to all older adults with hip fracture, not just those already malnourished. This study aimed to identify the proportion of inpatients in a sample of hospitals in two countries that were provided with oral nutritional supplementation (ONS) following a hip fracture and to identify factors associated with ONS provision. An analysis of prospectively collected data from a bi-national Hip Fracture Registry nutrition sprint and registry audit data limited to older adults (≥65 years) undergoing surgical intervention for a fractured hip from 1 to 31 August 2021. Multivariable logistic regression was used to identify factors associated with providing ONS. Patient-level data was available for 385 older adults (median 85 years; 60.5% female) admitted to twenty-nine hospitals. Less than half (n = 47.3%) of the audited inpatients were provided ONS. After adjusting for covariates, ONS was more likely to be provided to older adults who were identified as malnourished on formal testing (OR 11.92; 95%CI 6.57, 21.69). Other factors associated with prescription of ONS included those who did not have a preoperative medical assessment (OR 2.26; 95%CI 1.19, 4.27) or were cognitively impaired (OR 1.83; 95%CI 1.01, 3.32), severely frail, or terminally ill (OR 3.17; 95%CI 1.10, 9.17). ONS was provided in line with evidence-based recommendations for less than half of the older adults with a hip fracture in 29 hospitals in two countries. A structured approach to implementation may be required to reduce complications and improve outcomes for all older adults after a hip fracture, not just those assessed as cognitively impaired, frail, and/or malnourished.

Cemented Modular Bipolar Hip Hemiarthroplasty: Outcomes in Elderly with Femoral Neck Fracture

Cemented Modular Bipolar Hip Hemiarthroplasty: Outcomes in Elderly with Femoral Neck Fracture

A cost-effectiveness analysis of three surgical options for treating displaced femoral neck fractures in active older patients in Japan: A full economic evaluation.

For older patients with displaced femoral neck fractures, in which primary osteosynthesis is usually not indicated, there are three primary prosthetic options-bipolar hemiarthroplasty (BHA), single-bearing total hip arthroplasty (SB-THA), and dual-mobility THA (DM-THA). However, the optimal choice for managing displaced femoral neck fractures remains controversial. Accordingly, this study aimed to evaluate the cost-effectiveness of BHA, SB-THA, and DM-THA in active older patients with displaced femoral neck fractures. A decision tree combined with a Markov model was employed to analyze the cost and quality-adjusted life years (QALYs) of BHA, SB-THA, and DM-THA for the management in the Japanese healthcare system. By simulating the five-year trajectory of a 75-year-old woman treated for a displaced femoral neck fracture, the cost-effectiveness of the three surgical options was evaluated. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to assess parameter uncertainty. Additionally, two scenario analyses were conducted for other settings. The treatment was considered to be cost-effective when the incremental cost-effectiveness ratio (ICER) was below the 5,000,000 yen/QALY threshold. Compared with BHA, SB-THA exhibited higher costs but greater health benefits, resulting in an ICER of 1,499,440 yen/QALY. DM-THA offered additional health benefits compared with SB-THA, with an ICER of 4,145,777 yen/QALY. One-way sensitivity analysis revealed some influential parameters. PSA indicated that the probability of DM-THA, SB-THA, and BHA being cost-effective was 40.1%, 38.5%, and 21.4%, respectively. SB-THA was more cost-effective than BHA in patients aged 65-85 years, while DM-THA was more cost-effective than SB-THA in patients aged 65-75 years. The results suggest that SB-THA is a cost-effective alternative to BHA for displaced femoral neck fractures in active older patients, whereas DM-THA is more cost-effective than SB-THA in relatively younger patients. It is, therefore, recommended that orthopedic surgeons select the most appropriate surgical option based on the individual patient's physiological age.

Comparison of Short-Term Outcomes of DSA and ALMIS Approach for Bipolar Cemented Hemiarthroplasty in Patients with Neck of Femur Fracture.

Background/Objectives: A neck of femur (NOF) fracture is one of the most common fractures, and its treatment in the geriatric population using cemented bipolar hemiarthroplasty (HA) is a standard procedure worldwide. Various surgical approaches have been described for this operation, aiming to reduce complications and improve early mobilization. The present study compares two minimally invasive approaches, the anterolateral minimally invasive approach (ALMIS) and the direct superior approach (DSA), with respect to their intraoperative and early postoperative complications in cemented bipolar HA. Methods: The medical records of all patients undergoing cemented bipolar HA for a NOF fracture between January 2017 and December 2023 were analyzed. The aim of the study was to compare the two surgical approaches. The evaluation focused on intraoperative parameters and early complications. Results: A total of 226 patients were included in the analysis, with 62 undergoing DSA and 164 ALMIS, with an average age of 83.5 years. The two approaches did not differ significantly in terms of stem implantation quality, length of hospital or intensive care unit stay, postoperative mobilization, or the need for transfusions. However, the ALMIS was associated with a significantly shorter operative time (DSA: 89.7 min vs. ALMIS: 77.2 min; p < 0.01). On the other hand, the DSA had a significantly lower complication rate (DSA: 0/61 vs. ALMIS: 11/163; p = 0.04). Conclusions: In a comparison of the two minimally invasive approaches, DSA and ALMIS, for treating a NOF fracture with cemented bipolar HA, the DSA demonstrated a lower complication rate, though it had a slightly longer operating time.

Hip fracture in elderly: malnutrition and health outcomes. A systematic review and meta-analysis

Abstract Background Hip fracture is a common condition among elderly and one of the leading causes of disability. Malnutrition is widely present in older patients and has been identified in several studies as an important and modifiable prognostic factor for several medical conditions, including hip fracture. The aim of the present study is to evaluate the association between malnutrition, assessed by validated tools, and selected health outcomes for different follow-up intervals from hip fracture, in particular: mortality, changes in mobility/living arrangements and postoperative delirium. Methods A literature search on PubMed, Web of Science and Scopus databases up to September 2023, was conducted to identify all studies involving older subjects that reported an association between MNA/GNRI/PNI/CONUT score and health outcome after hip fracture. Meta-analysis was performed by a random-effects model using risk values (RR/OR/HR) extracted from 14 eligible selected studies. Results Malnutrition significantly increased the risk of any adverse outcome by 70% at 1 month, and up to 250% at 1 year, showing an increasing trend with longer follow-up periods. One month after hip fracture, malnutrition significantly increased the risk of postoperative delirium by 275% (OR = 2.75; 95% CI 1.80-4.18; p ≤ 0.05), mortality by 342% (OR = 3.42; 95% CI 2.14-5.48; p ≤ 0.05) and mortality hazard risk by 351% (HR = 3.51; 95% CI 1.63-7.55; p ≤ 0.05). One year after hip fracture, malnutrition significantly increased the risk of transfer to more supported living arrangements by 218% (OR = 2.18; 95% CI 1.58-3.01; p ≤ 0.05), declined mobility by 41% (OR = 1.41; 95% CI 1.14-1.75; p ≤ 0.05), mortality by 368% (OR = 3.68; 95% CI 3.00-4.52; p ≤ 0.05) and mortality hazard risk by 234% (HR = 2.34; 95% CI 1.91-2.87; p ≤ 0.05). Conclusions These findings underscore that malnutrition worsens outcomes after hip fracture in elderly, emphasizing the importance of nutritional assessment to mitigate potential adverse consequences. Key messages • The results of the present study underscore that malnutrition increases the risk of death and worsens mobility and independence after hip fracture in older adults. • Routine nutritional status evaluation could prove beneficial in the management of hip fracture older patients in order to prevent potential adverse outcomes.

Relationship between histological findings of vastus lateralis muscle and function after total hip arthroplasty in patients with hip fracture: a prospective cohort study.

We aimed to examine the histological characteristics of vastus lateralis muscles in patients undergoing total hip arthroplasty (THA) following femoral neck fractures and to explore the correlation between muscle fiber types and postoperative functional recovery. 34 patients undergoing THA for femoral neck fractures were included. A biopsy of the vastus lateralis muscle was performed during surgery, followed by immunohistochemical staining. Subsequently, image analysis was conducted to measure the average area of muscle fiber types and the number of type I and II muscle fibers, and the ratio of the area and the number of type II muscle fibers. Functional recovery was assessed 2 weeks post-surgery using the Short Physical Performance Battery (SPPB). A significant positive correlation was observed between type II muscle fibers and SPPB scores. The ratio of type II muscle fiber area and number strongly correlated with the SPPB scores, indicating a robust static association. The average area of type II fibers showed a strong correlation (r = 0.63, P < 0.001), as did the number of type II fibers (r = 0.53, P = 0.001). Moreover, the ratio of type II muscle fiber area and number significantly correlated with SPPB scores (area: r = 0.77, P < 0.001; number: r = 0.51, P = 0.002), indicating that larger and more numerous type II fibers are associated with better physical performance. The reduction of type II muscle fibers was strongly correlated with a low SPPB postoperative functional recovery in patients who underwent THA following femoral neck fractures.

Early Hip Dislocation Rate in a Consecutive Series of 1093 Primary Total Hip Arthroplasties Using Imageless Navigation

Purpose: Postoperative hip dislocation remains a major complication in total hip arthroplasty. Various studies have demonstrated that several factors influence dislocation. While computer-assisted navigation has been proposed to enhance component alignment, its impact on dislocation rates remains unclear. This study aimed to investigate the early dislocation incidence and associated risk factors in primary total hip arthroplasty (THA) using imageless navigation. Methods: A retrospective review of patients undergoing imageless-navigated THA between February 2013 and December 2022 was conducted. Inclusion criteria comprised primary THA with a minimum 6-month follow-up. Statistical analysis included univariate regression to identify dislocation risk factors. Results: A total of 1093 THAs were analyzed. Dislocation occurred in 16 cases (1.5%), six in elective procedures (0.76%), and 10 in femoral neck fracture (FNF) (3.28%). The univariate regression analysis revealed that FNF emerged as a significant risk factor (OR = 4.418, P = 0.004), while age, gender, femoral head size, and save zone cup placement of Lewinnek did not significantly affect dislocation rates. Conclusions: Navigation use showed a reduced rate of early dislocation. FNF is a factor associated with postoperative hip dislocation in primary THA.

Delirium and Cognitive Screening in National Hip Fracture Registries: Scoping Review Protocol

Background Delirium and cognitive impairment are common in hip fracture populations and are associated with significant adverse patient outcomes. National hip fracture registries facilitate improvements in patient outcomes and care quality, such as reduced mortality and the development of specialist multidisciplinary services. However, there is substantial variation in the data collected and reported in relation to delirium and cognition, which impedes international comparison and may reduce quality of care. Objective This scoping review aims to identify delirium and cognition data items currently collected by hip fracture registries internationally, to identify associated registry guidance that exists for the administration of delirium and cognitive screening tools, and report outcomes of these data items across the most recently published annual reports of identified hip fracture registries. Methods This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR). We will search the following databases: Medline Ovid; Embase; CINAHL EBSCOHost. Relevant websites such as the Fragility Fracture Network (FFN) will also be searched. Study selection and review will be carried out independently by two researchers, with discrepancies resolved by a third researcher. Data extraction and synthesis will be conducted by one reviewer and checked for accuracy and omissions by another. The scoping review findings will be informed and validated through engagement with the FFN Hip Fracture Audit Special Interest Group. Conclusion By identifying existing heterogeneity in delirium and cognitive screening tool use and administration, it is hoped that administration and specific screening tool use will become standardised to optimise comparability across countries and ensure that high quality and reliable data are included across international registry reports.

The admission inflammatory biomarkers profile of elderly hip fractures and its association with one-year walking independence and mortality: a prospective study.

Immune response plays an important role in the regulation of elderly hip fracture. This study aims to analyze the relationship between systemic inflammatory markers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) and mortality and walking independence, providing valuable references for the postoperative management of geriatric hip fracture. A retrospective analysis of prospective data on elderly patients who have undergone hip surgery and have been followed for at least one year. The receiver operating characteristic (ROC) curves and the optimum cutoff value were calculated. Univariate analysis and multivariate logistic regression analysis were used to identify the associations between admission four systemic inflammatory markers and one-year mortality and locomotion recovery. During the study period, respiratory disease was the most common cause of death, followed by cardiovascular disease. Multivariate analysis identified NLR (OR, 1.13; 95%CI: 1.09-1.17), SIRI(OR, 1.18; 95%CI: 1.08-1.28) and advanced age (OR, 1.06; 95%CI: 1.01-1.11) as independent risk factors for one-year mortality. In addition, 89 (rate, 31.8%) survivors had poor walking independence within one year. NLR (OR, 1.37; 95%CI: 1.26-1.50), SII(OR, 1.00; 95%CI: 1.001-1.003), SIRI(OR, 1.36; 95%CI: 1.18-1.57) and advanced age (OR, 1.08; 95%CI: 1.02-1.13) were associated with postoperative locomotion recovery. In summary, admission NLR and SIRI are correlated with a high risk of one-year walking independence and mortality, providing a basis for the clinical management of geriatric hip fractures.

Reduced Graphene Oxide-Substituted Nanohydroxyapatite: Rejuvenating Bone-Nerve Crosstalk with Electrical Cues in a Fragility Fracture Rat Model under Hyperglycemia.

Diabetes has currently acquired the status of epidemic worldwide, and among its various pathological consequences like retinopathy and nephropathy, bone fragility fractures from diabetic osteopathy occurs in later stages and is equally destructive. Chronic hyperglycemia culminates into deteriorating microvasculature and quality of bone, making it prone to fractures. Among these, hip fractures are most common, especially in older diabetic patients apart from underlying neuropathy. Our study is an attempt to ameliorate hip fragility fracture and nerve trauma with electrical stimulation as an interface in a chronic diabetic rat model. We have fabricated reduced graphene oxide-substituted hydroxyapatite as an electroactive bone substitute and incorporated it into chitosan gelatin cryogels. The in situ reduction of graphene oxide during sintering of hydroxyapatite imparts higher potential to the fabricated composite in dealing with problem at question. The cryogels depicted optimum in vitro biocompatibility and enhanced mineralization after ectopic subcutaneous implantation in rats. The therapeutic potency of composite cryogels was evaluated in a hip fracture model with compression to the sciatic nerve in diabetic rats, mimicking the severe clinical trauma. The presence of cryogels in the femoral neck canal coupled with electrical stimulation and biochemical factors significantly improved bone regeneration in diabetic rats as depicted with microcomputed tomography analysis and histology images. The application of electrical stimulation also ameliorated the nerve trauma observed with 70% improvement in electrophysiological parameters such as the compound muscle action potential with combinatorial therapy. We therefore report the successful implication of a multitarget therapy in a chronic diabetic rat model unraveling the bone-nerve crosstalk with electroactive smart cryogels.

Waiting for hip fracture surgery: Analysis of individual heterogeneity and discriminatory accuracy

Abstract Background Evaluation of healthcare inequality could be improved by considering (i) the intersection of socioeconomic axes of inequality, (ii) the existence of individual heterogeneity and (iii) criteria to quantify group differences and how those differences translate into recommendations for universal or targeted interventions. In this study we illustrate how to achieve these improvements. Methods We applied analysis of individual heterogeneity and discriminatory accuracy (AIHDA) to analyze data from the Swedish patient registry for the quality indicator hip fracture (HF) surgery within the same day. We analyzed 57,340 patients residing in Sweden during 2011-2014 and belonging to 36 socioeconomic strata defined by age, sex, income, and country of birth and the 21 Swedish regions. We calculated prevalences and 95% confidence intervals as well as the absolute number of cases. The benchmark was set to 80%. To quantify group differences, we evaluated the discriminatory accuracy (DA) using the area under the ROC curve (AUC). Results 68% (39,073/57,340) of the patients were operated in time. The prevalence across the 36 sociodemographic strata ranged from 51% (43-58%) to 81% (67-91%). However, the DA was low (AUC= 0.562) indicating very small group differences. About half of the operated HP (n = 20,287) occurs in 18/36 strata with the lowest prevalences of operations in time. The regions’ prevalences ranged from 37% (36-38%) to 88% (88-89%) with a rather high DA (AUC= 0.736) indicating larger differences. About half of the operated HP (n = 19,677) occurs in 12/21 regions with the lowest prevalence of operations in time. Conclusions The 80% benchmark was only achieved in one socioeconomic stratum and the group differences were very small. 6/21 regions achieved the benchmark and the group differences were large. Interventions aiming to reach the benchmark in the entire population should proportionately target regions and be universal and tailored to sociodemographic strata. Key messages • The AIHDA-framework improves evaluations of healthcare inequalities. • Both differences between group averages and the groups’ DA need be considered when planning healthcare interventions.